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General NPI Number Information
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NPI Number | 1699906297
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Entity Type | Organization
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Legal Business Name | OLIVER CHIROPRACTIC ACUPUNCTURE AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 208 ELDEN ST
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City | HERNDON
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State | VA
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Zip | 20170-4877
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Country | US
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Telephone | 703-904-8528
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Fax | 703-904-8529
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Provider Business Mailing Address
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Address Line | 208 ELDEN ST
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City | HERNDON
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State | VA
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Zip | 20170-4877
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Country | US
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Telephone | 703-904-8528
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Fax | 703-904-8529
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRIC T OLIVER
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Credential | D.C
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Telephone | 703-904-8528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0104001903
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License Number State | VA
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